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Burkholderia pseudomallei is the etiological agent of melioidosis. It is a gram-negative bacillus present in environment and intrinsically resistant to many antibiotics including aminoglycosides. However, recently aminoglycoside susceptible B. pseudomallei has been isolated from melioidosis cases and reported from some countries of the world. But, such aminoglycoside susceptible B. pseudomallei has never been detected in Bangladesh either from melioidosis cases or from environment. All the B. pseudomallei isolated so far in Bangladesh were resistant to gentamicin and other aminoglycosides. Here, we describe a disseminated case of melioidosis caused by aminoglycoside susceptible B. pseudomallei in a 55 years old Bengali male patient. This is the first case of melioidosis due to aminoglycoside susceptible B. pseudomallei in Bangladesh. IMC J Med Sci 2020; 14(2): 003. EPub date: 19 October 2020. OPEN ACCESS *Correspondence: Md. Shariful Alam Jilani, Department of Microbiology, Ibrahim Medical College, 1/A Ibrahim Sarani, Segunbagicha, Dhaka 1000, Bangladesh. e-mail: jilanimsa@gmail.com

Background and objectives: Leptospirosis is a zoonotic infection with worldwide distribution caused by the Leptospira species and predominant in the tropical and subtropical regions. Information on leptospirosis in Bangladesh is limited. The present study was designed to detect anti-leptospiral antibodies in human serum samples in Bangladeshi population by developing an in-house ELISA using recombinant LipL32 (rLipL32) antigen. The study was conducted from April 2014 to December 2014.Method: Healthy individuals from two rural areas and fever cases from one urban healthcare center were enrolled in the study. Rural health centers were located at Sonargoan and Bajitpur sub-district (Upozilla) of Narayaganj and Kishorganj districts. Sonargoan health center is located 26 km south-east and Bajitpur is located 71 km north-east of Dhaka city. About 1-2 ml of blood was collected with aseptic measure and serum was separated and stored at -200C until used. Anti-leptospiral IgG antibody was determined by recombinant LipL32 (rLipL32) antigen based indirect enzyme linked immunosorbent assay (ELISA). Seropositive cases were further confirmed by commercial Leptospira IgG ELISA.Results: The study included 250 febrile cases and 376 healthy individuals from urban and rural areas, respectively. Out of total 626 study population, anti-LipL32 specific IgG antibody was detected in 70 individuals (11.2%). The rate of positivity of anti-LipL32 antibody among the healthy individuals from rural area was 10.6% while the rate was 12.0% in urban febrile population. The rate of positivity in rural and urban population was not significantly (p>0.05) different. Among the urban population, the rate of seropositivity was 9.1% and 16.4% in 21- 40 yrs and above 40 years age group respectively while the rate was 7.2% and 14.0% in rural population respectively. Out of 70 seropositive cases detected by LipL32 ELISA, 65 (92.9%) were positive by commercial ELISA.Conclusion: The present study has revealed that leptospirosis is prevalent in Bangladesh and should be looked for in febrile and clinically suspected cases. The study has also demonstrated that rLipL32 protein may be used as a candidate antigen for the serodiagnosis of leptospirosis.IMC J Med Sci 2017; 11(2): 50-55

Background and objective – Disaster prone coastal population has least accessibility to health care and very little is known about the prevalence of diabetes, diabetic retinopathy (DR) and visual impairment. This study addressed the prevalence of visual impairment and DR and risk factors related to DR among population residing in disaster prone areas of Bangladesh. Methods : Thirty-two coastal communities in six coastal districts were purposively selected. All coastal people of age 18 years or more were considered eligible. Investigations included clinical history, anthropometry (height, weight, waist- and hip-girth), blood pressure and fasting blood glucose (FBG). The participants with hyperglycemia (FBG ≥5.6mmol/l) were undertaken for eye examination. Visual acuity was measured bilaterally using the Snellen chart. An Early treatment diabetic retinopathy study (ETDRS) cut out chart with E Optotypes was used. Results: A total of 7567 participants volunteered and 1540 had hyperglycemia (FBG ≥5.6mmol/l). Of the hyperglycemic participants, 1214 (91.7%) participated for complete eye examination. Visual impairment of any type was found in 14.1%, any type cataract in 27.8% and any type DR in 18%. The participants of advancing age of higher social class and higher central obesity had excess risk for developing DR. The participants with known family history of diabetes also had greater risk. Compared with the group having FBG 5.6 – 6.9mmol/l those having FBG >6.9mmol/l had significant risk for DR (OR 3.11, 95%CI 2.04 – 4.76). Conclusion : The study concludes that visual impairment and cataract of any type is almost comparable with other coastal populations. The coastal people had higher prevalence of DR compared to rural population from other areas of Bangladesh and it was also higher than global estimate. The persons with higher age from higher social class with higher central obesity had excess risk for DR. The risk of DR increased with increasing hyperglycemia. Further study may be undertaken to confirm these findings. IMC J Med Sci 2016; 10(1): 10-17

The present study was to assess the pattern of antibiotic susceptibility of the isolated bacteria in an urban referral hospital in Dhaka City. A total of 393 bacterial strains were isolated from various specimens over a l0-months period. The majority of the organisms were Escherichia coli Q3.33oh) followed by Klebsiella species (27.480 ), Staphylococcas aureus (l7.Oioh),Lcinetobacter species (8.l4yo), Pseudomonas species (7.l2Yo), and others. The thirdgeneration Cephalosporins Hke Ceftriaxone, Ceftazidime and Cefotaxime were sensitive against 45-66yo isolated Enterobacteriaceae. The first- and second-generation Cephalosporins were less effective. The sensitivity to Ciprofloxacin of various Enterobacteriaceae was only between 33-4Oo compared to 52.8-67.9Vo against Gentamicin. Majority of the Enterobacteriaceae were resistant to Ampicillin, whereas almost all of the Enterobacteriaceae (94- 100%o) were sensitive to Imipenem. Ahont97.UY;s Acinetobacter species were susceptible to Imipenem. Sensitivity of the organism (Acinetobacter) to third-generation Cephalosporins ranged between 50-560 , whereas 40.60/o were found sensitive to Ciprofloxacin. The sensitivity to Chloramphenicol, Co-trimoxazole, Cephalexin and Ampicillin ranged between 9.3oh to 34.30 . About 93.0%o of Pseudomonas species were sensitive to Imipenem. The rate of susceptibility to Gentamicin and Netilmicin was higher than those of the Ciprofloxacin and Ceftriaxone (67.80/o and, 53.57o vs, 39.2yo), About 707o of isolated S. aureus were resistant to OxacilHn but all were sensitive to Vancomycin. The result of this study would help the physicians to make a judicious choice of,.anti.biotics for therapeutic purposes. Bangladesh J Med Microbiol 2008; O2 (02):7-ll

The present study was undertaken to determine the drug resistance pattern of M. tuberculosis isolated from 225 pulmonary and 45 extrapulmonary tuberculosis cases. The samples were cultured on Lowenstein Jensen (L-J) media for isolation of M. tuberculosis. Drug resistance to first line anti tubercular drugsnamely isoniazid (INH), rifampicin (RIF), Ethambutol (ETH) and streptomycin (SM) were determined by indirect proportion method. The overall drug resistance of M. tuberculosis was 53.6% to any of the first line anti tubercular drugs. Rate of multi drug resistant tuberculosis (MDR-TB) among the untreated cases was 4.2%, while it was 36.0% in previously treated cases. It was found that 83.3% rifampicin resistant M. tuberculosis was cross resistant to one or more of other first line anti-tubercular drugs, while cross resistance of INH, ETH and SM resistant isolates was much low. The present study revealed that high level of drug resistance exists to individual anti tubercular drugs and MDR-TB is an emerging problem, particularly in treated cases. Rifampicin resistance could be used as a surrogate marker for drug resistance to other first line anti tubercular drugs.Ibrahim Med. Coll. J. 2014; 8(2): 41-46

The prevalence of non-communicable diseases (NCD) like diabetes, hypertension, dyslipidemia and atherosclerotic cardiovascular diseases (CVD) are on the increase globally and predominantly in the South East Asian Region (SEAR). The increasing NCD and its complications burdened the health cost of Bangladesh. The available literatures suggest that edible mushrooms are effective in controlling metabolic risks like hyperglycemia and hypercholesterolemia.The study addressed the metabolic effects of edible oyster mushroom (Pleurotus ostreatus) in diabetic individuals and to assess the undesirable effects of mushroom.A total of 5000 newly registered diabetic women were screened for eligible participants (urban housewives, age 30 – 50y, BMI 22 – 27, FBG 8 – 12 mmol/l; free from complications or systemic illnesses and agreed to adhere to the study for 360 days). The investigations included weight and height for BMI, waist- and hip-girth for WHR, BP, FBG, 2ABF, T-chol, TG, HDL, LDL, ALT and Creatinine starting from the day 0 (baseline) and each subsequent follow-up days: 60, 120, 180, 240, 300 and 360 for comparison between placebo and mushroom groups and also within group (baseline vs. follow up days), individually for placebo and mushroom. The daily intake of mushroom was 200g for the mushroom group and an equivalent calorie of vegetables for the placebo group.Overall, 73 diabetic housewives (mushroom / placebo = 43 /30) volunteered. The mean (with SEM) values of BMI, WHR, BP, FBG, 2ABF, T-chol, TG, HDL, LDL, ALT and Creatinine of the placebo group were compared with the mushroom group. Compared with the placebo, the mushroom group showed significant reductions of FBG (p

Background and objective: This study focused on the analysis and comparison of humoral immune response to Mycobacterium tuberculosis (MTB) cell wall fraction (CWF) and lipoarabinomannan (LAM) antigens. Methods: Sera from adult patients with active pulmonary tuberculosis and age and sex matched healthy individuals were tested for immunoglobulin (Ig) M and IgG antibodies to CWF and LAM by enzyme linked immunosorbent assay (ELISA). Results: The mean OD values of serum IgM and IgG antibodies against CWF of TB patients was not significantly (p=0.52, p=0.45) different from that of healthy control population. However, the mean OD values of serum IgM and IgG against LAM were significantly (p=0.049, p= 0.001) higher in TB cases than that of healthy individuals. Conclusion: The present study has revealed that IgM and IgG antibody to LAM may be used in serodiagnosis of TB while response to CWF in active TB case is restricted in our population. IMC J Med Sci 2016; 10(2): 58-60

Vancomycin and high level gentamicin resistant enterococci detection is important for effective treatment and control of nosocomial infection. The present study was undertaken to determine the species distribution of Enterococcus and the rate of vancomycin and high level gentamicin resistant enterococci (HLGRE) in clinical samples in a tertiary care hospital of Dhaka city. Enterococci were identified to species level by standard biochemical and serological methods. Their susceptibilities to antibiotics were determined by disc diffusion method according to CLSI guideline. Minimum inhibitory concentration (MIC) of vancomycin and gentamicin were determined by agar dilution method. The study was conducted from July 2009 to February 2010. Among 80 isolates, 95% and 5% were identified as Enterococcus faecalis and Enterococcus faecium respectively. Out of 80 isolates 72 (90%) were sensitive and 8 (10%) were intermediate resistant to vancomycin (30?g) by disc diffusion method, but all isolates were susceptible by agar dilution MIC method. Out of 80 enterococci, 37 (46.25%) showed high level resistance to gentamicin (MIC: > 500 ?g/ml) by MIC method but, initially six of which showed sensitive result to gentamicin by disc diffusion method using 120 ?g disc. The study indicated high prevalence of HLGRE in our hospital population. MIC method was more accurate in detecting high level gentamycin resistant enterococci compared to disc diffusion method with 120 ?g gentamicin disc. However, none of the enterococcal strains showed resistance to vancomycin. HLGRE should be monitored regularly in clinical samples as it is difficult to treat. DOI: http://dx.doi.org/10.3329/imcj.v7i2.20103 Ibrahim Med. Coll. J. 2013; 7(2): 28-31

Melioidosis, caused by Burkholderia pseudomallei, is a potentially fatal infectious disease. Early and correct diagnosis is important, as mortality in untreated melioidosis is high. The first case of melioidosis from Bangladesh was reported in 1988. Since then a few cases have been reported from Bangladesh. We report here four culture confirmed cases of melioidosis diagnosed in BIRDEM Genaral Hospital during May 2009 to April 2010.The detail demographic data, clinical features and outcome are discussed. We have also reviewed all the melioidosis cases among Bangladeshi population recorded from 1988 to 2014.Ibrahim Med. Coll. J. 2014; 8(1): 25-31

A cross sectional study was conducted in inpatient department of seven primary level hospitals care centers (PLHCs) and six tertiary level hospitals (TLHs) of the country. Total 2058 hospitalized patients were interviewed over a six month period from October 2012. Most of the patients (85.9% in TLH and 100% in PLH) were prescribed with antibiotics at the time of admission. Only 6.4% patients of TLHs treated with antibiotic had culture proven infection and rest of the patient of TLH and all the patients of PLH were treated with antibiotic empirically. Top prescribed antibiotic was ceftriaxone (39.64% in TLH, 59.64% in PLH). Parenteral route of antibiotic administration was preferred for both at TLHs and PLHCs (63.3% and 76.9%). The results of the present study indicated that antibiotics were widely and inappropriately used without following standard guidelines or based on any rationality. This is an alarming situation, and needs to be addressed by the relevant authority to save the people from growing antibiotic resistance.Ibrahim Med. Coll. J. 2015; 9(2): 42-44

Mecillinam is one of the very few oral antibacterial agents used against extended spectrum β- lactamase (ESBL) producing Escherichia coli (E. coli) causing urinary tract infection (UTI)). It is reported that, resistance to mecillinam can be reversed to some extent by adding beta lactamase inhibitor like clavulanic acid. The present study was aimed to determine in-vitro activity of mecillinam and mecillinam-clavulanic acid combination on the susceptibility of ESBL producing and non-ESBL producing E. coli . Total 124 E. coli (78 ESBL positive and 46 ESBL negative) isolates from urine samples of patients with UTI were included in the study. Organisms were isolated from patients attending BIRDEM General Hospital from July 2012 to December 2012. ESBL production was tested by double disc synergy test. Minimum inhibitory concentration (MIC) of mecillinam and clavulanic acid against E. coli was determined by agar dilution method. Of the total E. coli isolates, 62.9% was ESBL positive and 37.1% was negative for ESBL. Out of ESBL positive isolates, 75.6% was sensitive to mecillinam while ESBL negative isolates showed the sensitivity as 67.4%. The sensitivity to mecillinam of ESBL positive and negative isolates increased to 85.9% and 86.9% respectively by addition of clavulanic acid with mecillinam. The MIC values of intermediate and resistant isolates converted to sensitive MIC range after addition of clavulanic acid with mecillinam. Conversion of resistance of ESBL producing isolates by adding clavulanic acid was also evident by the reduction of MIC 50 and MIC 90 from 4μg/ml to ≤1 μg/ml and from 128 μg/ ml to 64 μg/ml respectively. Similar trend of reduction of MICs was also observed in non-ESBLs. In conclusion, both ESBL positive and negative E. coli demonstrated considerable sensitivity to mecillinam and the sensitivity increased significantly (p

A definitive and accurate diagnosis of tubercular lymphadenitis is important for its proper management. Fine needle aspiration cytology (FNAC) is an easy procedure for collection of material for cytopathological and bacteriological examination. But the detection rate of M. tuberculosis from the aspirated material is low with Ziehl-Neelson (Z-N) stain and even with culture. Polymerase chain reaction (PCR) is a rapid method for diagnosis of tuberculosis from various clinical samples. In the present study, PCR was employed for the detection of mycobacterial DNA sequences in fine needle aspirates of twenty cases of suspected tubercular lymphadenitis and compared with cytomorphological characteristics, Z-N stain and culture. Thermo stable multiplex PCR was used to detect Mycobacterium specific DNA. The rate of PCR positivity for mycobacterial DNA was 70% as compared to 50% and 60% by Z-N stain and culture respectively. Papanicolaou as well as Hematoxylin and Eosin (H&E) stains of fine needle aspirated (FNA) materials detected granulomatous lesions suggestive of tubercular infection in only 50% cases. FNAC with Type 3 cytomorphological pattern without presence of granuloma yielded highest positivity rate by PCR. PCR was found more sensitive technique to detect Mycobacterium in patient with tubercular lymphadenitis. DOI: http://dx.doi.org/10.3329/imcj.v6i2.14728 Ibrahim Med. Coll. J. 2012; 6(2): 46-49

Nosocomial infection is an endemic problem encountered in hospitalized patients all over the world including Bangladesh. The present prospective study was carried out on 152 patients who were admitted in Dhaka Medical College Hospital and BIRDEM Hospital over a two years period to determine the organisms responsible for nosocomial infection, their antibiotic susceptibility pattern, sources and the impact of hospital infection on patient management. Samples were collected from postoperative wounds, post catheterized urinary tract infection (UTI) and diabetic wounds. The patients without postoperative wound infection were taken as control group. To trace the sources of infection the samples from the different objects of the hospital environment were studied. The collected samples were cultured and isolated organisms were identified by colony morphology, gram staining and necessary biochemical tests. The identified organisms were tested for antibiogram pattern and plasmid profile. The predominating organisms responsible for nosocomial infection were Esch.coli (55.9%) . The other organisms were Pseudomonas sp. (33.3%), Proteus sp. (12.7%), Staphylococcus aureus (5.9%), Klebsiella sp. (4.9%) and Acinatobacter sp. (3.9%). The isolated organism showed high level of resistance to commonly used antibiotics. The resistance of the organisms markedly increased with the hospital stay. The hospital stay of the infected cases was significantly (p

Salmonella enterica serovar Typhi ( S. Typhi) is occasionally associated with abscess formation in various organs of the body. But breast abscess by S. Typhi without the general and specific symptoms of typhoid fever is unusual. We report a case of breast abscess due to S. Typhi in a 20 year old nonlactating diabetic female without the features of typhoid fever. DOI: http://dx.doi.org/10.3329/imcj.v7i1.17743 Ibrahim Med. Coll. J. 2013; 7(1): 16-17

Critically ill patients admitted in intensive care units (ICU) are always at a higher risk of developing infections with various antibiotic resistant organisms. The objective of this study was to know the antibiotic resistance pattern of the common isolates from blood, urine, respiratory secretions and pus/wound swab of patients admitted in ICU at BIRDEM (Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorder) hospital, during a one year period from March 2006 to February 2007. A total of 1660 samples were analyzed. Growth was obtained in 34% of the samples yielding 632 organisms. The major organism isolated were Pseudomonas sp. (29.1%), Acinetobacter sp. (27.5%), Candida sp. (12.8%), Escherichia coli (10.3%) and Klebsiella sp. (9.7%). Staphylococcus aureus, Enterobacter sp, Citrobacter sp, Enterococcus sp, Providencia sp and Serratia sp accounted for 10.6% of the isolates. All the isolates were highly resistant (>80%) to cephalosporins and fluoroquinolones. The frequency of third generation cephalosporin resistant E. coli, Klebsiella and imipenem resistant Pseudomonas and Acinetobacter were >50%. Acinetobacter was remarkably resistant to most antibiotics including imipenem (>70% resistant), but most of the members of the Enterobacteriacae group showed maximum sensitivity to imipenem (50%-94%). The findings of this study might help clinicians to formulate their first line empirical antibiotic treatment regimens for the patients admitted in ICUs. Ibrahim Med. Coll. J. 2010; 4(2): 66-69

Enteropathogenic Escherichia coli (EPEC) is a major cause of diarrhea in children below 5 years of age in the developing countries. The present study investigated the role of EPEC in childhood diarrhea among the patients attending a university hospital in north-eastern peninsular Malaysia by serotyping and cell adhesion assay using HEp-2 and HeLa cells. A total of 60 stools or rectal swabs from watery diarrhea cases and 16 age matched healthy controls were examined. EPEC were isolated from 14 (23.3%) diarrhea cases and from 1 (9.1%) control by serotyping. Of the 14 EPEC strains, the predominant strain was 0125: K70 (28.5%). Cell adhesion assay detected 26.6% and 30.0% adherent Escherichia coli (E. coli) in diarrhea cases by HEp-2 and HeLa system respectively. Three adherence patterns were noted namely localized, diffuse and aggregative patterns. About 81-88% of isolated E. coli exhibited diffuse adherence pattern by HEp-2 and HeLa cell assay respectively. About 43-44% E. coli exhibiting positive cell adherence phenotype with HEp-2 and HeLa cell assays tested negative with EPEC antisera. The findings indicate that EPEC is an important cause of childhood diarrhea in north-eastern peninsular Malaysia and cell adhesion assay is more sensitive than serotyping for detection of diarrheogenic E. coli. Ibrahim Med. Coll. J. 2008; 2(2): 40-43

The prevalence of extended-spectrum beta-lactamases (ESBL)-producing organisms in an urban hospital in Dhaka City was assessed over a 10-month period. A double disk test was performed to detect ESBL-producing Escherichia coli and Klebsiella pneumoniae. 43.2% and 39.5% of E. coli and K. pneumoniae had ESBL phenotypes, respectively. The combination of augmentin with ceftazidime detected the most ESBL-producing E. coli (39.5%) while augmentin with ceftriaxone was the best combination for the detection of ESBL (31.6%) in K. pneumoniae.

The antibiotic resistance pattern of salmonella is ever changing over time. The present study is a retrospective analysis of rate of isolation of Salmonella Typhi and Paratyphi and their antibiotic resistance pattern over 6 years period in an urban hospital of Dhaka city. Blood culture submitted in BIRDEM hospital from 2004-2009 were analyzed. Isolated Salmonella sp were identified and antimicrobial susceptibility testing was carried out by a standard disc diffusion method. Among 385 isolated Salmonella sp 304 (79%) were Salmonella enterica serovar Typhi and 81 (21%) were Salmonella enterica serover Paratyphi A. The rate of isolation of S. Paratyphi A has increased over 6 the year period from 14% to 24%. Resistance to individual first line anti-salmonella drugs has increased from 2004 to 2006 (42 to 63%) but has decreased thereafter. Similar pattern was found when simultaneous resistance to three first line antibiotics namely ampicillin, chloramphenicol and co-trimoxazole were considered. Out of total 304 S. Typhi, 117 (38%) were simultaneously resistant to all three first line drugs compared to only 1.8% S. Paratyphi A. Analysis showed that 80 to 90% of isolated S. Typhi was nalidixic acid resistant (NARST) with reduced susceptibility to ciprofloxacin while the rate for S. Paratyphi A was 71-94%. All S. Typhi and Paratyphi A were sensitive to ceftriaxone. The study showed that there was a gradual decline of resistance of S. Typhi to first line antibiotics but very high prevalence of nalidixic acid resistant S. Typhi and S . Paratyphi in Bangladesh. DOI: http://dx.doi.org/10.3329/imcj.v5i2.10097 IMCJ 2011; 5(2): 42-45

DOI: 10.3329/imcj.v4i1.5925Ibrahim Med. Coll. J. 2010; 4(1): i-ii

DOI: http://dx.doi.org/10.3329/imcj.v6i2.14726 Ibrahim Med. Coll. J. 2012; 6(2): i-ii

Salmonella enterica serovar Typhi (S. Typhi) is occasionally associated with abscess formation in various organs of the body. But breast abscess by S. Typhi without the general and specific symptoms of typhoid fever is unusual. We report a case of breast abscess due to S. Typhi in a 20 year old non-lactating diabetic female without the features of typhoid fever. Ibrahim Med. Coll. J. 2013; 7(1): 16-17

Conservative medical management of chronic suppurative otitis media (CSOM) is an important step in achieving a dry ear. Topical antibiotic ear drops and aural toilet form the mainstay of medical management of noncholesteatomatous CSOM. This study analyzes the causal organisms and their sensitivity to various antibiotics. Out of 382 swabs examined, the major organisms isolated were Pseudomonas aeruginosa (27.2%), followed by Staphylococcus aureus (23.6%). The sensitivity of P aeruginosa was 100% to ceftazidime, 98.9% to ciprofloxacin, 96.3% to gentamicin, and 95.4% to polymyxin B, whereas the sensitivity of S aureus was 98.6% to ciprofloxacin, 97.4% to cloxacillin sodium, 96.5% to cotrimoxazole, and 90.7% to gentamicin. Pseudomonas aeruginosa was almost completely resistant to ampicillin (97.6%) and chloramphenicol (96.6%), whereas S aureus was almost completely resistant to ampicillin (73.8%) and polymyxin B (98.3%). Among the available topical antibiotic preparations for use in the ear, we found that ciprofloxacin and gentamicin are the best choices.

We describe a Malay girl with disseminated cryptococcosis affecting the lungs, liver, lymph nodes and bones. The diagnosis was made by culture of the bone marrow. Tests of immune function showed that she was HIV-negative but the CD4 percentage was persistently low. Idiopathic CD4+ T-lymphocytopenia was diagnosed. The child died despite two courses of anti-fungal therapy.

Wet India ink mounts of cerebrospinal fluid (CSF) are useful in the laboratory diagnosis of cryptococcal meningitis. Pseudo-cryptococcal artefacts in such mounts have been attributed to leucocytes in CSF but their mode of formation has not been explained. This report describes the reproduction of such an artefact in cryptococcus free CSF-leucocyte mixtures that had been subjected to high speed centrifugation. The viscosity of DNA that could provide a morphological pseudo-capsule, and the yellow-green fluorescence of the pseudo-capsular material on staining with acridine-orange, suggest that lymphocytic nuclear DNA, which possibly leaked out after damage to the lymphocyte membrane by centrifugation, was responsible for this artefact.

A simple, safe and effective procedure for improving the bacterial isolation in chronic suppurative otitis media (CSOM) is described. It is most useful for the isolation of aerobes as well as anaerobes from the middle ear.

Critically ill patients admitted in intensive care units (ICU) are always at a higher risk of developing infections with various antibiotic resistant organisms. The objective of this study was to know the antibiotic resistance pattern of the common isolates from blood, urine, respiratory secretions and pus/wound swab of patients admitted in ICU at BIRDEM (Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorder) hospital, during a one year period from March 2006 to February 2007. A total of 1660 samples were analyzed. Growth was obtained in 34% of the samples yielding 632 organisms. The major organism isolated were Pseudomonas sp. (29.1%), Acinetobacter sp. (27.5%), Candida sp. (12.8%), Escherichia coli (10.3%) and Klebsiella sp. (9.7%). Staphylococcus aureus , Enterobacter sp , Citrobacter sp , Enterococcus sp , Providencia sp and Serratia sp accounted for 10.6% of the isolates. All the isolates were highly resistant (>80%) to cephalosporins and fluoroquinolones. The frequency of third generation cephalosporin resistant E. coli , Klebsiella and imipenem resistant Pseudomonas and Acinetobacter were >50%. Acinetobacter was remarkably resistant to most antibiotics including imipenem (>70% resistant), but most of the members of the Enterobacteriacae group showed maximum sensitivity to imipenem (50%-94%). The findings of this study might help clinicians to formulate their first line empirical antibiotic treatment regimens for the patients admitted in ICUs. Key words: Intensive care units; antimicrobial resistance pattern; bacterial profile. DOI: 10.3329/imcj.v4i2.6499 Ibrahim Med. Coll. J. 2010; 4(2): 66-69

Enteropathogenic Escherichia coli (EPEC) is a major cause of diarrhea in children below 5 years of age in the developing countries. The present study investigated the role of EPEC in childhood diarrhea among the patients attending a university hospital in north-eastern peninsular Malaysia by serotyping and cell adhesion assay using HEp-2 and HeLa cells. A total of 60 stools or rectal swabs from watery diarrhea cases and 16 age matched healthy controls were examined. EPEC were isolated from 14 (23.3%) diarrhea cases and from 1 (9.1%) control by serotyping. Of the 14 EPEC strains, the predominant strain was 0125: K70 (28.5%). Cell adhesion assay detected 26.6% and 30.0% adherent Escherichia coli (E. coli) in diarrhea cases by HEp-2 and HeLa system respectively. Three adherence patterns were noted namely localized, diffuse and aggregative patterns. About 81- 88% of isolated E. coli exhibited diffuse adherence pattern by HEp-2 and HeLa cell assay respectively. About 43-44% E. coli exhibiting positive cell adherence phenotype with HEp-2 and HeLa cell assays tested negative with EPEC antisera. The findings indicate that EPEC is an important cause of childhood diarrhea in north-eastern peninsular Malaysia and cell adhesion assay is more sensitive than serotyping for detection of diarrheogenic E. coli. Ibrahim Med. Coll. J. 2008; 2(2): 40-43 Key Words: EPEC, diarrhea, serotyping, Malaysia doi: 10.3329/imcj.v2i2.2935

Identification of organisms and effective antibiotic therapy is an important component of treatment of diabetic foot infections. This study was undertaken to determine the organisms associated with diabetic foot infection (DFI) and their antibiotic sensitivity pattern. A total of 75 patients having type 2 diabetes mellitus with Wagner's grade 1-5 foot ulcers attending BIRDEM hospital were included in the study. Specimens were processed for aerobic culture. The bacteriological isolation and antimicrobial sensitivity tests of the isolates were done by standard microbiological methods. Gram negative bacilli were tested for extended spectrum â lactamase (ESBL) production by double disc diffusion method. Culture was positive in 92% of the cases which yielded 135 pathogens. Of the positive culture, 75.3% had multiple organisms. Polymicrobial infection was more in higher grade of foot ulcers. Gram negative organisms were most frequently isolated (80%) bacteria. Pseudomonas (48%) and Proteus sp.(33%) was the most common Gram negative organisms isolated. Staphylococcus aureus was the most commonly isolated gram positive organism (21.3%). ESBL production was noted in 31.5% Gram negative bacilli and methicillin resistance was noted in 43.8% of Staphylococcus aureus. Most of the Gram negative bacilli were resistant to various classes of antibiotics. Imepenem was the most effective agent against Gram negative organisms, while vancomycin was for staphylococcus. The present study has shown that infection with multidrug resistant Gram negative bacilli is the most common cause of DFI in BIRDEM hospital. Ibrahim Med. Coll. J. 2009; 3(2): 50-54 DOI: 10.3329/imcj.v3i2.4216

Urinary tract infection (UTI) is common both in the diabetic and non-diabetic patients. The widespread use of antimicrobial agents leads to emergence of resistant microorganisms. Since the pattern of bacterial resistance is constantly changing, the monitoring of the antimicrobial susceptibilities of the predominantly isolated organisms becomes more important. Aim of this study was to determine the etiologic agents and their antibiotic sensitivity pattern in both diabetic and non-diabetic patients with urinary tract infection (UTI). A total of 288 diabetics (196 female and 92 males) and 63 non diabetic patients (43 female and 20 males) with symptomatic UTI were included in this study. Among the study cases, 43.8% diabetic patients and 42.9% non-diabetic patients had positive growth from urine. Rate of isolation of Escherichia coli in diabetic was less (61.8%) compared to non diabetic (77.8%). Rate of other organisms isolated in diabetic and non diabetic patients were respectively: Klebsiella sp 6.9% vs 3.7%, Enterococcus 12.2% vs3.7%, Pseudomonas species 3.8% vs 0%, Candida species 4.6% versus 3.7%, Staphylococcus aureus 4.6% versus 7.4% etc. E coli isolated from diabetic patient was significantly (p

Among the various beta-lactam antibiotics, carbapenems are the most potent and have been reserved for use in treating infections caused by multi-drug resistant (MDR) Gram negative bacilli, especially Pseudomonas. They are effective even against Extended Spectrum beta-lactamase (ESBL) and Amp C b-lactamase producing bacteria. The clinical utility of carbapenems is under threat with the emergence of carbapenem resistant bacteria due to production of carbapenem hydrolyzing metallo-beta-lactamase (MBL) which confers high-level resistance to all b-lactam antibiotics except aztreonam. The prevalence of MBLs have been studied in many countries but not been reported in Bangladesh. The purpose of the study to determine the presence of MBLs producing Pseudomonas in clinical samples from a tertiary care hospital. MBLs producing Pseudomonas in various clinical samples of an urban hospital of Dhaka city was investigated over a 6-month period (January 2009-June 2009). EDTA-IMP agar dilution minimum inhibitory concentration (MIC) reduction method was employed to detect MBL producing Pseudomonas sp. Out of 44 Pseudomonas isolates 08 (18.2%) were sensitive and 23 (52.3%) were resistant to imipenem while 13 (29.5%) were intermediate resistant (MIC = 8 μg/ml) to imipenem. All Pseudomonas showing intermediate resistance to imipenem were found sensitive by disc diffusion method. MBL phenotype was detected in 43%(10 out of 23) imipenem resistant Pseudomonas spp. while the rate was 61%(08 out of 13) is intermediate resistant strains by EDTA-IMP agar dilution MIC method. The results of the study indicated high prevalence of MBL producing Pseudomonas spp. in our hospital environment. Early detection of these MBL producing Pseudomonas is necessary to institute appropriate treatment and effective infection control measures. Key words: Metallo-ß-lactamase, Pseudomonas species, Gram negative bacilli. DOI: http://dx.doi.org/10.3329/bjmm.v4i1.8469 BJMM 2011; 4(1): 43-45